{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EINAHPETSYRNEH A  ","gend":1,"add":"XOB OP8713 ","city":"TAPPAHANNOCK","state":"VA","zip":22560,"dob":"1964-10-10","age":"","mstatus":"","insh":"09200210*64","cliId":"","pno":"02\/0457237-7","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/443-5378","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":22560,"pcpcounty":"","pcpid":"","pcpname":"TAPPAHANNOCK PRIMARY CARE","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N12.","N39.0","D64.9","E11.65","I10.","E66.01","E78.00","Z79.4","Z68.34","R10.10","R10.13","I50.9","K44.9","K29.50","E11.9","J45.20","R05.","R10.9","N17.9","R10.84","E11.40","M06.9","N10.","Z23.","K21.9","B96.20","E86.0","Z79.899","R78.81","R65.10","E08.42","Z13.220","R00.0","J01.00","R06.00","G62.9","J45.909","R29.898","E53.8","Z79.84","Z20.822","L02.31","Z87.891"],"date":["2019-04-16","2019-04-16","2019-04-16","2022-10-18","2022-11-23","2019-04-16","2022-10-18","2022-10-18","2019-04-16","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2022-11-23","2020-08-17","2020-08-17","2019-04-02","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2019-04-08","2019-04-02","2022-10-18","2019-04-02","2019-04-02","2022-10-18","2019-04-08","2019-04-08","2020-05-15","2020-05-15","2019-04-01","2022-02-16","2022-02-18","2022-10-18","2022-02-18","2022-10-18","2022-10-18","2022-10-18","2022-01-05","2022-11-23","2022-11-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","CHLORTHALID"," CHLORTHALID ","30","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","90","Select","Select",""],["","","LOSARTAN"," LOSARTAN ","30","Select","Select",""],["","","LANTUS"," LANTUS ","9","Select","Select",""],["","31604001870","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","90","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8","Select","Select",""],["","81131038679","RELION","MIS 32GX4MM","100","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","56151149403","TRUE","KIT AIR","1","Select","Select",""],["","76204010060","IPRATROPIUM","SOL 0.02%INH","125","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","","FLOVENT","AER 44MCG","","Select","Select",""],["","31604004070","D3","TAB 1000UNIT","90","Select","Select",""],["","00955172901","INSULIN","SOL 100U\/ML","15","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","NORTRIPTYLIN","CAP 25MG","","Select","Select",""],["","","QVAR","AER 40MCG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}